This is a Congressionally mandated study. In the original study, 16 demonstration programs provided care coordination services to beneficiaries with chronic illness in Medicare's fee-for-service program. A five-year CMS-funded study tested whether the programs can improve patients' use of medical services, improve patients' outcomes and satisfaction with care, and reduce Medicare costs. The study also assessed physicians' satisfaction with the programs.

In 2008 Congress extended the project for two of the original programs--Mercy Medical Center - North Iowa and Health Quality Partners in Pennsylvania--and they will enroll Medicare beneficiaries and provide care coordination services into the spring of 2010.

Depending on the demonstration site, may consist of nurse telephonic counseling and monitoring, nurse in-person or home visits, home telemonitoring equipment, patient educational materials, patient group educations classes, physician education and feedback.

No Intervention: Control

Usual care in Medicare fee-for-service from beneficiaries' physicians and other health care providers

Detailed Description:

Mathematica Policy Research, Inc. (MPR) evaluated 16 independent demonstration sites that provide coordinated care interventions to Medicare beneficiaries with chronic illnesses. The rationale for the demonstration is the lack of coordination among the multiple providers typically serving Medicare beneficiaries with chronic illnesses, as well as the adverse consequences of the lack of coordination for the beneficiaries and for Medicare costs. The demonstration sites, selected in early 2001, offered programs designed to improve both the care that patients receive and patients' knowledge of, and adherence with, recommended self-care and behavior. The study estimated the effects of each site on patients' well-being and satisfaction, in addition to the site's effects on the use and cost of Medicare covered services. This analysis relied on a patient survey conducted 6 to 12 months after enrollment, and on Medicare claims data and any data available from the demonstration sites that could enhance the study. The study included two rounds of physician surveys. In each site, eligible applicants were randomly assigned to treatment and control groups. An extensive process analysis was conducted to describe the interventions in detail, with the key goal being an assessment of those factors that account for program success and failure. The study included case studies of each site, program profiles, interim site-specific memos, two interim summary reports, two reports to Congress (based on the interim summary reports), and a final summary report. This original study enrolled 18,277 beneficiaries.

In 2008 Congress extended the study for 2 of the sites, Mercy Medical Center - North Iowa and Health Quality Partners in Pennsylvania, and they will recruit beneficiaries and provide demonstration intervention services through the spring of 2010. Mathematica Policy Research will evaluate the results of this extended demonstration using Medicare claims data and qualitative site visits to the two programs.

Eligibility

Genders Eligible for Study:

Both

Accepts Healthy Volunteers:

No

Criteria

Inclusion Criteria:

Meets clinical and prior health service use criteria of each of the 16 demonstration sites (vary across demonstration programs)

Resides in catchment area of one of the programs

Enrolled in Medicare fee-for-service program

Coverage by both Medicare Parts A and B

Medicare is primary payer

Exclusion Criteria:

Does not meet any of the relevant program's exclusion criteria (vary across demonstration programs)

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study.
To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below.
For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00627029

Locations

United States, Arizona

Hospice of the Valley MediCaring Project

Phoenix, Arizona, United States, 85016

United States, District of Columbia

Georgetown University Medical Center-Mind My Heart Program

Washington, District of Columbia, United States, 20036

United States, Florida

Quality Oncology/Matria Healthcare

Sunrise, Florida, United States, 33323

United States, Illinois

CorSolutions/Matria Healthcare

Rosemont, Illinois, United States, 60018

Carle Foundation and Hospital

Urbana, Illinois, United States, 61801

United States, Iowa

Mercy Medical Center - North Iowa

Mason City, Iowa, United States, 50401

United States, Maine

Medical Care Development

Augusta, Maine, United States, 04330

United States, Maryland

University of Maryland Medical Center

Baltimore, Maryland, United States, 21201

Charlestown/Erickson Retirement Communities

Catonsville, Maryland, United States, 21228

United States, Missouri

Washington University-St.Louis School of Medicine/Barnes-Jewish Hospital